Intensivists

Dinith88 · Aug 20, 2006

Since the inception of my unit, we have had intensivists (currently looking for two or three more). In my opinion, they make my life a lot easier. Since they manage all the patient care (98% of the time), I don't have to try to figure out which doc to call about what problem or having too many 'fingers in the pie' and the right hand not knowing what the left hand is doing.
There are units in which it is an automatic consult to the unit's intensivists upon admission if admitted by another service. Our intensivits admit to the unit or are consulted by the admitting service (but not mandated).

WE dont use them where i work. I'm not sure i even like the idea.

When you say they manage '98%' of patient care, do you mean the unit uses less consultants/ologists (only 2% of the time??) If/when a specialist is consulted, does the intensivist call the guy, or is the nurse still supposed to do this?

I can envision consultants and other doctor-types coming through the unit to see patients and not even communicating with the nurse as they'll go right to the intensivist...Are they relegating the icu nurses to drug-pushing technicians with less reason to think?

Perhaps it's just a misconception, but i would feel a little(a lot) less autonomous if an intensivist were at my side 24/7. Other than that, i suppose it'd be nice not to have to call people at 3am...or wait for guys to return pages.

But again, i've never worked with them, so i'm just guessing at how the dynamics (in my unit) would change if we were to utilize them.

I wonder what percentage of hospitals use them nation-wide? I know the bigger university/teaching-type hospitals use them more than the average community-type hospital. I'm curious about that...

RoxanRN · Aug 21, 2006

WE dont use them where i work. I'm not sure i even like the idea.
When you say they manage '98%' of patient care, do you mean the unit uses less consultants/ologists (only 2% of the time??) If/when a specialist is consulted, does the intensivist call the guy, or is the nurse still supposed to do this?

I work in a specialized unit - Neuro Critical Care. Our intensivist is a neurologist board certified in critical care. It's usually the neurosurgons consulting him (or vice versa). Usually the overflow medical/cardiac ICU patients and Trauma Services usually don't consult (we get the head/spine injuries).

I can envision consultants and other doctor-types coming through the unit to see patients and not even communicating with the nurse as they'll go right to the intensivist...Are they relegating the icu nurses to drug-pushing technicians with less reason to think?

When our intensivist is consulted, the admitting generally takes a back seat until such time as the patient is moved to the floor. We work very closely with our intensivist and have quite a bit of influence.

Perhaps it's just a misconception, but i would feel a little(a lot) less autonomous if an intensivist were at my side 24/7. Other than that, i suppose it'd be nice not to have to call people at 3am...or wait for guys to return pages.

They aren't 'at our side 24/7.' They are generally there during daytime hours. We still have to call them at night, but we are expected to know what to call now and what we can do and then call in the morning. That's what is so nice about working so closely with only a handful of physicians - it's much easier to anticipate orders.

But again, i've never worked with them, so i'm just guessing at how the dynamics (in my unit) would change if we were to utilize them.
I wonder what percentage of hospitals use them nation-wide? I know the bigger university/teaching-type hospitals use them more than the average community-type hospital. I'm curious about that...

I can't tell you how many are used around the country. The smaller hospitals seem to be gravitating toward eICUs (I think) - https://allnurses.com/forums/search.php?searchid=2211801 .

augigi, CNS · Sep 10, 2006

I have always worked with intensivists in critical care in Australia. They still get consults if they need specialist advice, it's just that they are experts in critical care (and, often, internal medicine or anesthesia) permanently located in the ICU. They are the most knowledgeable docs I have worked with, and I love all the ones I worked with!

indigo girl · Sep 10, 2006

When I worked in ICU, we had only one intensivist. He was a pediatric intensivist, and was awesome to work with. The other docs, typically on the unit, were either medical or surgical residents. I loved working with most of them, but that pedi guy made all us feel better having him around.

wonderbee, BSN, RN · Sep 13, 2006

I love working with the intensivists. Truly I don't know why they show up at some times and not at others, nor am I sure what their role is. Calling a code would bring them in but we work our own codes so there's no announcement. One in particular I work with is an awesome teacher. To see her guide the residents and even teach us nursing staff a thing or two is something I look forward to.

gwenith, BSN, RN · Sep 15, 2006

Most of the ICU's in Australia are run by intensivists. You have to hold a double specialty here to be an intensivist - usually Anaesthetics plus or some allied discipline. They are awesome as they truly think holistically (and I don't mean they think of the patient as a series of holes into which to place tubes:p). The problem is that it can be a great mechanism to pass on problems - especially in private hospitals - your patient is not doing so well and it is 5 pm on a friday - call the intensivist and get them transferred to ICU - then you have a nice weekend:(

NeuroICURN · Dec 4, 2006

Well, obviously intensivists have different roles in different hospitals and I've had good and bad experiences with them.

I did several months of travel nursing this past summer....and the intensivists at the hospital there were truly clueless!!! I was amazed at their lack of knowledge.....especially after working with the intensivists at my home hospital. It was actually scary!

Now, the intensivists at my home hospital (where I'm back working), are ABSOLUTELY WONDERFUL!!! It's a group of MDs who are pulmonologists, but also specialize in ciritical care medicine.

In our unit, they're consulted probably 99.9% of the time. They handle the medical management side of the patient. This means they handle the ventilator and resp. stuff, the meds for stuff that the primary service doesn't initially order or they need later, antibiotic therapies, etc., etc., etc. They're in the unit from about 4 or 5 a.m. till about 5 or 6 pm and then they have two from the service there till about 10 p, I think, and then someone is there all night covering.

So, does this mean that other services don't get consulted when needed...NO!!! They consult other services as needed and do so quite frequently. They're very good at knowing when it's something they can easily handle or if some other expert should be on the case.

So, how does it work? Well, each intensivist spends a month in each unit that they cover (now one MD does always stay in the CVICU). The big reason for that is to give them a break. Our unit is VERY busy and after about a month, they need that break, so they might go to the MICU next. However, they also continue to follow them on the regular nursing floors as long as needed.....thus continuity of care. Each month, one of them works on our stepdown unit, so they just take over from their partner when the pt. comes out of the ICU.

Basically, I think they're great and they're also great teachers!! There's one MD in particular who is SOOOOO darn smart, it's almost scary and he's taught me a LOT about medicine. Granted, there are 3 of them that are my favorites from the practice...but overall, they're all good. thankfully, those 3 are the ones who are with our unit most. I would trust my entire life with any of those three, even on their worst day!!